Ekonomi Bölümü Koleksiyonu
Permanent URI for this collectionhttps://hdl.handle.net/20.500.11779/1936
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Conference Object Pms37 - Health Care Cost Burden and Demographic Distribution of Patients Diagnosed With Psoriatic Arthritis in the Us Medicare Population(Elsevier Science Inc, 2015) Li, L; Mao, X; Shrestha, S; Başer, Onur; Yuce H.; Li Wang; Yuce, H.; Wang, L.OBJECTIVES: To investigate the health care cost burden and demographic distributionof patients diagnosed with psoriatic arthritis (PSA) in the Medicare fee-for-service(FFS) Dataset. METHODS: A retrospective database analysis was performed usingthe 100% Medicare FFS Datasets from October 1, 2008 through December 31, 2012.Patients diagnosed with PSA were identified using International Classification ofDiseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnosis code 696.0, andthe index date was the date of the initial diagnosis. All patients were required to havecontinuous medical and pharmacy benefits 1-year pre- and post-index date. Healthcare costs and utilization during the baseline (1 year before the diagnosis date) andfollow-up (1 year after the diagnosis date) periods were calculated. RESULTS: Usingthe aforementioned criteria, 11,324 PSA patients were identified. The average ageat diagnosis was 74 years, 66.10% of patients were women and almost 92.36% werewhite. The majority of patients resided in the South U.S. region (39.01%). Diabetes(33.84%), chronic obstructive pulmonary disease (29.04%) and cerebrovascular disease(17.36%) were the main comorbidities observed during the baseline period. Duringthe follow-up period, 62.96% of patients had inpatient admissions, 47.29% had emergency room visits, 91.67% had outpatient office visits, 91.67% had outpatient visitsand 58.03% had pharmacy visits, costing, on average, $23,960, $237, $5,015, $5,252and $7,335, respectively. The average total cost of PSA patients was $36,548. The fivemost commonly prescribed medications for PSA were methotrexate sodium (4.54%),prednisone (3.37%), levothyroxine sodium (2.59%), hydrocodone bit/acetaminophen(2.43%) and simvastatin (2.11%). CONCLUSIONS: PSA patient demographic and healthcare cost information was obtained and the most commonly prescribed PSA medications were identified.Conference Object Citation - WoS: 1Pnd29 - a Retrospective Analysis of the Economic Burden Among Patients Diagnosed With Chronic Migraine Using the Veterans Health Administration Medical Data(Elsevier Science Inc, 2015-05-01) Mao, X; Shrestha, S; Başer, Onur; Wang, LOBJECTIVES: To evaluate the health care resource utilization and costsamong patients diagnosed with chronic migraine (CM) in the Veterans HealthAdministration (VHA) medical dataset. METHODS: Patients diagnosed with CMwere identified (International Classification of Diseases, 9th Revision, ClinicalModification diagnosis code 346.XX) using the VHA dataset from October 1, 2008through September 30, 2010. The initial diagnosis date was designated as the indexdate. Patients without CM with the same age, gender and region (comparison cohort)were matched using a randomly chosen index date to minimize selection bias.Patients in both cohorts were at least age 18 years and had continuous medicaland pharmacy benefits for 1 year before and after the index date. One-to-one propensity score matching (PSM) was used to compare health care costs and utilizations between the CM and the comparison cohorts, and was adjusted for baselinedemographic and clinical characteristics. Pain scores were also included to investigate wellness after CM diagnosis. RESULTS: After risk-adjustment by PSM, 123,241patients in each cohort were matched. Significantly more CM patients had inpatientadmissions (6.44% vs. 1.75%, p<0.0001) and emergency room (ER; 14.42% vs. 5.50%,p<0.0001), outpatient office (68.80% vs. 42.15%, p<0.0001), outpatient (69.30% vs.42.91%, p<0.0001) and pharmacy visits (70.84% vs. 41.43%, p<0.0001) compared tothose without CM. Accordingly, CM patients also incurred higher costs for inpatient admissions and ER, office, outpatient and pharmacy visits compared to thosewithout CM. Total costs incurred by CM patients were $4,776, almost triple that of patients without CM ($1,756). There were more CM patients with accompanying painat all levels (mild: 19.53% vs. 0.16%; moderate: 13.10% vs. 0.10%; severe: 16.20% vs.0.12%; all p<0.0001). CONCLUSIONS: CM patients in the VHA population had substantial health care resource utilization, incurred higher costs and suffered worsepain compared to those without the disease.Conference Object Citation - WoS: 2The Relationship Between Medical Innovation and Health Expenditures(Elsevier Science Inc, 2016-11-01) Çınaroğlu, Songül; Guzel, E; Başer, OnurObjectives: It is widely accepted that medical innovation includes many costly activities, and that it is a key driver of rising health care expenditures. Understanding the relationship between medical innovation and health care expenditures is critical for health policy makers to effectively make resource allocation decisions. This study seeks to investigate the relationship between medical innovation and health care expenditures. Methods: We assessed data from the World Intellectual Property Organization and World Bank statistics for the year 2014, which included data from 72 countries. The number of patent publications in the categories of medical technology, biotechnology, and pharmaceuticals were included as medical innovation indicators; public heath, health care costs per capita, and total health care costs (percentage of gross domestic product [GDP]) were included as indicators of health care-related expenditures. A canonic correlation analysis (CCA) was performed to examine the degree of association between the sets of medical innovation and health care expenditure variables. Results: Study results indicate that there is a strong positive correlation between medical innovation and health care expenditure variables (rc= 0.68, p<0.001). Conclusions: In light of this study, health policy makers should manage the relationship between medical innovation and health care expenditures with a focus on accessibility. Improved communication channels in the social system, increased international cooperation, and the determination of a proper balance between the benefits and costs of innovation may help to continue improving medical innovation and enhance health care accessibility. We hope that the study results offer an increased awareness of the relationship and balance between innovation and expenditure, and will help to create an improved health system.Article Citation - WoS: 7Citation - Scopus: 8The Use of Decomposition Methods in Real-World Treatment Benefits Evaluation for Patients With Type 2 Diabetes Initiating Different Injectable Therapies: Findings From the Initiator Study(Elsevier Science Inc, 2017-12-01) Ke, Xuehua; Buysman, Erin; Wei, Wenhui; Xie, Lin; Grabner, Michael; Brekke, Lee; Başer, OnurBackground: Determining characteristics of patients likely to benefit from a particular treatment could help physicians set personalized targets. OBJECTIVES: To use decomposition methodology on real-world data to identify the relative contributions of treatment effects and patients' baseline characteristics. METHODS: Decomposition analyses were performed on data from the Initiation of New Injectable Treatment Introduced after Antidiabetic Therapy with Oral-only Regimens (INITIATOR) study, a real-world study of patients with type 2 diabetes started on insulin glargine (GLA) or liraglutide (LIRA). These analyses investigated relative contributions of differences in baseline characteristics and treatment effects to observed differences in 1-year outcomes for reduction in glycated hemoglobin A1c (HbA1c) and treatment persistence. RESULTS: The greater HbA1c reduction seen with GLA compared with LIRA (-1.39% vs. -0.74%) was primarily due to differences in baseline characteristics (HbA1c and endocrinologist as prescribing physician; P < 0.050). Patients with baseline HbA1c of 9.0% or more or evidence of diagnosis codes related to mental illness achieved greater HbA1c reductions with GLA, whereas patients with baseline polypharmacy (6-10 classes) or hypogylcemia achieved greater reductions with LIRA. Decomposition analyses also showed that the higher persistence seen with GLA (65% vs. 49%) was mainly caused by differences in treatment effects (P < 0.001). Patients 65 years and older, those with HbA1c of 9.0% or more, those taking three oral antidiabetes drugs, and those with polypharmacy of more than 10 classes had higher persistence with GLA; patients 18 to 39 years and those with HbA1c of 7.0% to less than 8.0% had higher persistence with LIRA. CONCLUSIONS: Although decomposition does not demonstrate causal relationships, this method could be useful for examining the source of differences in outcomes between treatments in a real-world setting and could help physicians identify patients likely to respond to a particular treatment. Copyright (C) 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.Article Citation - WoS: 3Citation - Scopus: 3Cancer Chemotherapy Treatment Patterns and Febrile Neutropenia in the Us Veterans Health Administration(Elsevier Science Inc, 2014-09-01) Wang, Li; Dale, David C; Barron, Richard; Langeberg, Wendy J; Başer, OnurBackground: The Veterans Health Administration (VHA) is the largest integrated health care system in the United States and a major cancer care provider. Objective: To use VHA database to conduct a population-based study of patterns of myelosuppressive chemotherapy use and to assess the incidence and management of febrile neutropenia (FN) among VHA patients with lung, colorectal, or prostate cancer or non-Hodgkin lymphoma (NHL). Methods: Data were extracted for the initial myelosuppressive chemotherapy course for 27,899 patients who began treatment in the period 2006 to 2011. FN-related costs were defined as claims containing FN diagnosis. Results: Most patients were men (98.0%); most were 65 years or older (55.8%). Patients received a mean 3.4 to 3.9 chemotherapy cycles/course (median cycle duration 34-43 days). The incidence of FN among patients with lung, colorectal, or prostate cancer or NHL was 10.2%, 4.6%, 5.4%, and 17.3%, respectively. Primary or secondary prophylactic antibiotics/colony-stimulating factors were received by 21% and 12% of patients, respectively. Antibiotics were more commonly given as primary or secondary prophylaxis for patients with lung, colorectal, and prostate cancer; colony-stimulating factors were more common for patients with NHL. Among patients with FN, those with lung cancer had the highest inpatient mortality (10%); patients with NHL had the highest costs ($24,571) and the longest hospital length of stay (15.4 days). Conclusions: VHA cancer care was generally consistent with National Comprehensive Cancer Network recommendations; however, compared with the general population, chemotherapy cycles were longer, combination chemotherapy was used less, and treatment to prevent FN was used less, differences that may be attributed to the unique VHA patient population. The impact of these practices warrants further investigation.Conference Object Pmh26 - Comparing Healthcare Resource Utilization and Costs Among Schizophrenic Patients Who Initiated Typical Vs. Atypical Long-Acting Injectables in the Us Veteran Population(Elsevier Science Inc, 2015-05-01) Başer, Onur; Kariburyo, M. Furaha; Du, J; Xie, LOBJECTIVES: To evaluate healthcare resource utilization and costs among schizophrenic patients who initiated typical and atypical long-acting injectables (LAIs) inthe U.S. veteran population. METHODS: Using the Veterans Health Administration(VHA) Medical SAS datasets, patients with ?1 pharmacy claim for LAIs were identified from 01OCT2005 through 30SEPT2012. The first LAI date was designated asthe index date. Patients were required to be age ?18 years, have continuous healthplan enrollment for 12 months pre-index date and a schizophrenia diagnosis(International Classification of Diseases, 9th Revision, Clinical Modification [ICD9-CM] code 295.xx) during the study period. Patient data was observed until theearlier date of death or the end of the study period, and patients were assigned totypical LAI (fluphenazine, haloperidol, perphenazine) or atypical LAI (aripiprazole,olanzapine, paliperidone, risperidone) antipsychotic cohorts. All-cause (follow-up)and psychiatric disorder-related healthcare resource utilization and costs wereassessed. Follow-up health care costs were adjusted to per-patient-per-month.The generalized linear model (GLM) was used to assess cost and utilization differences among the cohorts. RESULTS: A total of 4,796 patients were identified(Typical LAI cohort: N=1,941; Atypical LAI cohort: N=2,855). Typical LAI patientswere older (age 53.81 vs. 50.94 years, p<0.0001) and more likely to be black (34.47%vs. 28.27%, p<0.0001) than atypical LAI patients. After adjusting for baseline differences using GLM, more patients prescribed typical LAIs had all-cause emergencyroom [ER] visits (61.66% vs. 58.11%, p=0.024) and inpatient stays (63.11% vs. 59.00%, p=0.008) and psychiatric disorder-related ER visits (33.83% vs. 30.05%, p=0.011)than those prescribed atypical LAIs. However, typical LAI patients incurred lowerall-cause pharmacy ($197 vs. $433, p<0.001), total ($2,850 vs. $3,073, p=0.048) andpsychiatric disorder-related total costs ($1,615 vs. $1,624, p=0.908) than atypical LAIpatients. CONCLUSIONS: Although patients who initiated typical LAIs had highhealthcare resource utilization, their economic burden was lower compared to thosewho initiated atypical LAIs.